Urgent care centers are on the rise

Monday

Dec 26, 2016 at 7:00 AMDec 28, 2016 at 7:36 AM

Gerry Tuoti Wicked Local Newsbank Editor

When they need stitches, X-rays or treatment for a nasty bug, more patients are opting to visit walk-in urgent care centers instead of taking a trip to the hospital emergency room or a traditional doctor’s office.

“More Americans are seeking care in an on-demand, convenience-focused environment,” said Shaun Ginter, an Urgent Care Association of America board member and president and CEO of the CareWell Urgent Care chain. “Urgent care centers cater to busy lifestyles and the needs of patients.”

Often tucked into strip malls alongside restaurants and retail stories, urgent care centers represent one of the fastest-growing segments in U.S. medical care. The Urgent Care Association of America estimates there are 9,300 such clinics nationally, with roughly 1,300 of them opening since 2008. Urgent care centers see an average of four patients per hour, or close to 50 each day. Nearly 90 percent report their number of patient visits is increasing, according to the UCAOA.

A different model for care

While urgent care centers are often equipped to take X-rays, perform blood tests, set casts and suture wounds, they are not designed to handle major emergencies. Patients with serious trauma and life-and-limb-threatening conditions are typically referred to a hospital emergency room.

“We know what we can do and what we can’t do,” said Bing Yeo, managing director of AFC Urgent Care centers in Marlborough and Natick. “We know we’re not here to address life-threatening situations.”

Unlike traditional primary care doctors’ offices, urgent care centers are usually open during evenings and weekends, with no appointments needed. Unlike emergency rooms, they are typically less expensive and have shorter wait times, usually less than 30 minutes.

Some, however, wonder if that convenience comes at a cost.

Dr. David Gilchrist, vice president of the Massachusetts Academy of Family Physicians, said that although urgent care centers fill a need, he’s concerned patients may increasingly only seek care when they’re ill or injured, instead of going to primary care physicians for ongoing preventive care.

“If you’re just showing up at urgent care, all you’re going to get is sick care,” he said. “You’re not going to get preventive care.”

When Gilchrist has a patient who comes in with a sore throat, for example, he may also notice the patient is overdue for a diabetes blood test, has gained weight or has another health condition that needs monitoring.

“We’re trying to get away from sick visit care and toward a model of coordinated, comprehensive care at all times,” he said.

The growth of urgent care, Gilchrist said, shows there is a demand for quick, convenient treatment.

“I do think integrated, comprehensive primary care is a much better model,” he said. “It’s on family and primary care to be innovative about how we provide that care.”

For more-serious, potentially life-threatening ailments, patients are encouraged to go to a hospital emergency room. Emergency rooms can also treat less-serious conditions, but often have longer wait times and higher costs than urgent care centers. The most-pressing and severe cases are typically prioritized.

Nationally, urgent care centers refer about 2 percent of their patients to emergency rooms for treatment, according to the Urgent Care Association of America.

Factors fueling growth

In Massachusetts, where there’s a prominent academic medical establishment and large population of primary care doctors, urgent care centers haven’t historically gained the sort of traction they’ve previously enjoyed in other parts of the country, Ginter said. That began to change a few years ago, when the Affordable Care Act led to a surge in the number of insured patients seeking care.

“It seems like things are moving very fast in Massachusetts, but Massachusetts is very late to the party,” Ginter said. “Urgent care has existed around the country for a couple decades, but it’s about a 5-year-old industry here in Massachusetts.”

A search for ways to control rising health care costs has also been a major factor in the growth of the urgent care industry, he said. The average urgent care visit costs $150, compared to $1,354, according to the UCAOA.

“There’s an inherently high cost with a hospital ER,” Ginter said. “They have very high-cost and highly qualified people and are typically designed as a trauma setting. We’re not staffing with trauma surgeons and heart doctors. In hospital systems, everything is fully integrated and designed for life-or-death situations.”

Perhaps the largest factor, though, is convenience, he said.

Finding a niche

CareWell opened its first center in 2012, and now has 16 in Massachusetts and one in Rhode Island. In recent years, the chain has entered into affiliations with hospital systems, including Lahey Health, Mount Auburn Hospital and UMass Memorial Health Care.

Other hospitals are also becoming involved in urgent care.

Partners HealthCare has opened urgent care centers in Brookline, Watertown and Newton. Massachusetts General Hospital also now has a walk-in urgent care unit in Boston.

“Massachusetts hospitals support the basic premise of urgent care centers, which is to provide primary care access to patients who do not need the more-sophisticated care that emergency rooms provide,” Massachusetts Health & Hospital Association President and CEO Lynn Nicholas stated. “Some Massachusetts hospitals have developed their own urgent care centers, as well as fostering affiliations with other primary care clinics, to alleviate crowding in their emergency departments and provide capacity for more critically ill patients.”

While urgent care centers like CareWell and AFC accept patients with Medicare and Medicaid, some do not. It’s also common for urgent care centers to only accept uninsured patients if they pay up front in cash. Nicholas called for the urgent care industry to provide better access for all patients.

“Urgent care centers, like emergency rooms, should accept and welcome all patients, including those covered by Medicaid and those without insurance,” Nicholas stated. “These patients are often the most in need of access to primary care. In addition, as more health care providers in Massachusetts move to value-based care models, freestanding urgent care centers must ensure that lines of communication with all of a patient’s caregivers -- including hospitals -- is transparent and occurs in real time, so patients can receive truly coordinated care.”

Yeo, who invested into Doctors Express in 2011, comes from a business background. He anticipates there is still room for urgent care to grow before hitting a saturation point. AFC, which acquired the Doctors Express chain two years ago, has 18 urgent care centers in Massachusetts, with plans to expand to 20 in the coming months.

“ERs are congested. Most primary care doctors don’t have X-rays on site,” he said. “I thought this was a good model. It’s more consumer-friendly.”

Yeo views urgent care as a complement, not a competitor, to traditional doctors’ offices and emergency rooms.

He drew an analogy to grocery stores.

“We have large supermarkets like Wegmans, then we have Stop & Shop, Hannaford and even CVS. Then you have convenience stores. You can buy a carton of milk from any one of those places,” he said. “Primary care, ERs, urgent care, we are all part of the overall health equation.”